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everett I CHART NOC-�- .-2�'�_� <br /> e ,��s���ra <br /> City of Everett _ �� `Z'/ / �? �/ <br /> Engineering & Co:nmunity Services � <br /> Sewer qpp�i��tion nnd Permit � , <br /> NO. , ,' �,�i DATE <br /> Service Address . '% ' -� <br /> " Utility Account No. <br /> Billing qddress — <br /> `'� Permit Fee �' <br /> City, State, Zip <br /> - . Connection Charge(s) ""--"'- <br /> Owner (Mortgagor) / <br /> � <br /> '� Total Fee - <br /> Billing Name _.__ — <br /> Connection By <br /> Address <br /> -----_ Signed <br /> Phone � - ;/ � �,-" c�:mm���—__--- <br /> DESCRIPTION: .; `,�" � '� !i'-�+` . =. . <br /> Lot_ Block i%.-� , Sewer District _ _ __ _ <br /> Plat `� � Monthl�SewerSen�ir.e <br /> Unplatted Description -- <br /> Monthly Sewer Constr. <br /> Type Permit: _ -- Trunk <br /> Remarks: Lateral <br /> Abuiting Lot Line <br /> . N, S, E, W <br /> — ft, <br /> —�_ Approved By�__ <br /> Ciry Enyinucr <br /> Issued By_�_ <br /> �_ <br /> Inspection By�������--y�`,�A��? <br /> 3 Date Inspected ��r���'� ,� <br /> SEESKETCH ATTACHED <br /> ..� .. . ;, .- ;�.:: ,.. i�i� . <br /> �'�ar, t�� �'p� ��y'Nix•�� ��:�. <br /> � " +LG� y w <br />